Coding Auditor

Coding Auditor

Binghamton, NY

Weekly hours: 40

Shift: Days

Experienced candidates may be eligible for a sign-on bonus of up to $5,000.
Early-career candidates may qualify for up to $11,000–$17,000 in tuition forgiveness.

Position Overview

This auditor performs quarterly internal coding and documentation audits for CDI and inpatient coders. They will research, analyze, and respond to inquiries regarding coding and documentation compliance in accordance with all coding guidelines and Medicare/Medicaid regulations. This position works closely with the Cobius Team to review all denials and submits written appeals, when appropriate. They are responsible for monthly education for the CDI and inpatient coding staff. They also assist with coding, documentation, and billing questions to ensure compliant coding and billing. This auditor will develop final audit reports based on findings/observations during the audit process to present to providers or other appropriate staff members. Also, they will help identify areas for audit opportunities based on industry performance, regulatory focus areas and risk areas within the organization. The customers served include CDI specialists, inpatient coders, physicians, nurses, physician offices, emergency department, managed care contracting dept, quality management, risk management, insurance companies, patient accounting, finance, and governmental agencies.

Essential Functions:

• Conducts and facilitates prospective review of medical records to ensure that coding complies with all coding guidelines and UHS coding policies.
• Conducts and facilitates prospective review of medical records to ensure that provider documentation complies with externally mandated guidelines to substantiate reimbursement per UHS policy.
• Facilitates system audits to compare documented services with itemized physician statements to identify discrepancies, preclude inadvertent duplication or incorrect coding, and to retrieve missed charges. Completes insurance audits as directed by the carrier. Completes incentive reviews for payers.
• Prepares reports of individual employee, provider and departmental activity for distribution to Administration, as requested or deemed appropriate by the Director of Health Information Management.
• Cooperates and collaborates with Medical Records Department, Physicians’ billing and insurance representatives, Clinical Managers, Compliance team and UHS Internal Auditing team.
• Maintains knowledge of ICD-9 CM, CPT codes, modifiers and ICD-10.
• Collaborates with Clinical Documentation Specialists and Coding Educators to identify areas of educational opportunity to improve compliance. Maintain current knowledge and educate providers, supervisors, and office staff on the legislation changes, changes in CPT, ICD-10 CM codes, and coding guidelines - changes in the rules and guidelines for Medicare, Medicaid and other major payers.
• Maintains CEUs necessary for AHIMA and/ or AAPC credentials.

Position Requirements

Education/Experience

Minimum Required:

• RHIT, CCS or RN
• Three (3) years of inpatient coding experience

Preferred:

• RHIA
• Auditing experience in the healthcare field

License/Certification

Minimum Required:

• RHIT, RHIA, CCS or RN

Preferred:

• See information above; level of education/experience is tied to certification.

Employee Benefits at United Health Services

When you work at United Health Services, you become part of our family. We’re proud to offer competitive benefits and compensation to our employees who make an impact every day.

• Health, dental, and vision insurance
• Voluntary benefits, including cancer, pet, and life insurance
• 403(b) retirement plan with company match model
• Immediate accrual of paid time off
• Wellness program rewards and insurance discounts
• Employee Assistant Program (EAP) counseling and concierge services
• Free, extensive online training through HealthStream
• Tuition reimbursement and education incentive programs to further your education, particularly in nursing or allied health fields

About United Health Services

United Health Services is a not-for-profit healthcare system serving more than 500,000 people in Upstate New York’s Southern Tier region. We offer integrated healthcare services across 60 locations, including four hospitals, three walk-in centers, and 22 primary care offices, in addition to home care services and senior living facilities. The United Health Services system employs more than 6,300 people and comprises 600+ providers who are all committed to providing and supporting the delivery of exceptional patient care.

United Health Services employees and providers are “LOVED!” This means we’re Living Our Values Every Day. Here, you’ll join a team that is dedicated to values-based, coordinated patient care. Every day, we outwardly live our Values of Compassion, Trust, Respect, Teamwork, and Innovation.

United Health Services in an Equal Opportunity Employer.

United Health Services, Inc. and the members of the UHS System neither are affiliated with, sponsored, endorsed nor approved by, nor otherwise associated with, Universal Health Services, Inc. (NYSE: UHS), UHS of Delaware, Inc. nor their affiliates, which can be found at www.uhsinc.com.